Expert: Joyce A. Anthony - 8/27/2010

Question
Hi my mum was finally diagnosed Bipolar after 38 years of being wrongly diagnosed, she had an acute manic attack when she was 16 %26 since then which we have now realised through out the years she has gone through numerous episodes of hypomania %26 then crashed into depression %26 anxiety until last year in June when this time my dad %26 I realised the signs that she was hypomanic, waking early, spending, arranging to do lots of things etc etc when we asked her she of course said she was fine but then come November she went into full blown Mania %26 was hospitalised for 3 months, she was delusional, paranoid %26 psychotic, thought my dad was going to kill her, that she was lady Dianna, that she was pregnant as well as numerous other things, she probably only slept for 2hours a night!!

It took the doctor 3 months to get the mania under control finally putting her on Sodium Valproate 2000mg, 800mg quetiaping %26 50mg phenergan to help her sleep.  She was discharched in March %26 came home %26 she was hypomanic but within a week she switched into severe anxiety %26 depression %26 has been really struggling since then.

She was admitted to hospital again 1 month ago now for the Anxiety/Depression as nothing she has been given has worked!!  She can't take ssri's or venlafine because of the side effects, she was taking Mirtazepine which she has been fine on in the past but this time hasn't helped at all %26 the 800mg quetiapine not doing a thing anymore. So over the past 2 weeks the Mirtazepine has been stopped %26 the quetiapine %26 the phenergan has been cut to 25mg at night %26 she is now on 700mg Lithium %26 200mg Trazadone to help her sleep but she is still really really struggling %26 saying she can't take any more!!  We have asked the doc if he can give her something else along with the Lithium %26 Trazadone to help with the depression %26 anxiety %26 he has said no he's just leaving her on that.

We are now looking to at taking her out of hospital %26 having to go private again!! Do you know of any medications that work well for depression %26 anxiety that can be taken with Lithium?

Sorry for the length of the email but just wanted to give you an overall picture of what's happened over the years.

Look forward to hearing from you.

Many thanks

Nicola

Answer
Hi, Nicola:

Unfortunately, I can't make a suggestion regarding what medications to add with Lithium because I would need a complete medical background, etc.  I do know, however, that lithium is being used less and less as newer solutions are becoming available.  Talk to your mother's doctor about taking her off the Lithium and trying Lamictal.  See what he has to say about that, coming from the perspective of his expertise and familiarity with your mother.  Lamictal seems to be the one drug that is effective on almost everyone, without the usual side effects other drugs have.

                       Joyce A. Anthony